Guidelines to Successful Weight Loss Surgery
Many people tell me they know this “friend” who had weight loss surgery and gained all the weight back. It is true that some people may regain the weight, but I am willing to bet that more than 50% of those cases have a non-mechanical (i.e. not a surgical) reason. I always tell people that there are three reasons for weight regain after bariatric surgery, all three are involved in all cases, and the degree of each cause varies among different patients. They are 1.) Mechanical problems (the surgery is malfunctioning), 2.) Psychological (e.g. comfort foods), and 3.) Educational (eating things they shouldn’t). It is imperative that anyone who has had weight-loss surgery commit themselves to life-style changes for life. Once they have lost all they weight they are going to lose after surgery, hitting the plateau, they are in the same boat as anyone: diet and exercise to maintain.
So if you have had bariatric surgery, how can you make sure that you don’t fall into those “bad habits” and regain the weight? Below are guidelines to follow in order to achieve success with the Bariatric program. All successful patients have these things in common.
• Consumption of an adequate amount of liquid, preferably water, is crucial. You should consume a minimum of 48 to 64 ounces of liquid each day. This can only be done slowly, sipping fluids throughout the day. Never drink more than 2 ounces of liquid over a 10 to 15 minute period. This is necessary in order to prevent dehydration. Studies have also proven that drinking 20 ounces of water before bed is a great metabolism booster.
• Solid foods should only be eaten 3 times per day (this should correspond to meal times). Between meals you should avoid snacking on small amounts of food throughout the day. Snacks are to be small, about 1/3 to 1/2 the size of your meals. The purpose of a snack is to simply hold you over to your next meal. They should be no more than 100 calories. Ideally, a snack will prevent you from being very hungry before your next meal which may cause you to eat too fast and become ill.
• The primary source of nutrition should be protein. Aim for a minimum of 60 grams daily, such as eggs, fish, meat, etc. Carbohydrates (whole grains, fresh fruits and vegetables, etc.) and fats (butter, oil, etc.) should make up the rest of your diet. Your intake will be approximately 1000 to 1200 calories at your final stage. Protein is vital to maintaining a good muscle mass. The more muscle mass you have, the more calories you burn at rest. Muscle is good, so resistance training is very important. Yes, it is true that muscle weighs more than fat, but this should not deter anyone from packing on as much muscle as they can. Muscle is healthy tissue. Aim to be lean!
• Never drink liquids when eating solid foods. Liquids should be avoided for a period of 30 minutes before and 30 minutes after eating solid food or meals. This is because of the “funnel effect.” If there is food sitting on top of the small opening of a gastric pouch or band, for example, then the liquids you pour in on top will have no place to go. They sit in the esophagus and your body’s natural inclination will be to void this liquid out of the esophagus. This is not pleasant nor socially acceptable in most instances.
• Avoid foods that contain sugar. Not only will they slow down your weight loss, but they can make you sick. Sugar causes dumping syndrome in patients who have had the gastric bypass procedure. Dumping, in short, is when sugars go directly from your stomach pouch into the small intestine causing heart palpitations, nausea, abdominal pain, and diarrhea.
• Stop eating/drinking when you begin to feel full. Do not “stuff” yourself. This may cause vomiting and your stomach pouch may stretch. Most of the stapling procedures (like sleeve gastrectomy, gastric bypass, and the duodenal switch operations) work through hormonal mechanism that will tell your body you are full very quickly. This takes away our hunger, and it is not related to the amount of food you eat. The old saying, “clean your plate,” still rings in my ears. But after weight-loss surgery this is not a good idea. Some tricks to avoid this is to eat on really small plates (4-6 inches in diameter) and use children size utensils. This reminds you not to put too much food on your plate and to take small bites.
• It is essential that, within the first 6 weeks after surgery, you begin with a regular exercise program. Stay motivated; it will make a dramatic difference in your energy level and your weight loss. Exercise is hard at first if we do not do it regularly, but it can be a very positive experience when we see the results. A little bit, 5 days a week, can do wonders. To stimulate weight loss, it is estimated that a person should exercise 45-60 minutes per day, 5 times per week. This is a lot, I agree, but it is well worth it. Any exercise is good. But I suggest mixing it up between cardio and strength training. Always look for new exercises that are fun to do.
• Regularly attend support group meetings. They will help you stay focused and motivated and help you deal with the challenges of weight loss. We are social creatures by nature. We want to hear about what works for others, and learn from other’s mistakes. We want to share our highs and lows, and we want to be a positive influence for others, most of the time. Support groups are a great place to get a “pick-me-up” when you feel low.
So that’s it. Those are the general rules to successful weight loss after bariatric surgery. If you follow these basic guidelines, I promise you that you will lose the weight you want and keep it off. If you want to learn more about these topics, come in and see me. I love to talk to my patients about their success and failures, and encourage them to live a healthier life.
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